Wednesday, May 27, 2015

How infertile patients delude themselves

I get very frustrated when infertile patients come to us after many years of marriage , and find that they’ve taken no medical treatment during this time. I wonder why they've chosen not to do anything – don’t they realize the harm they cause to their chances of having a baby as a result of their inactivity ? This waiting and watching approach means that the woman’s fertility declines progressively with the passage of time – and after the age of 35, ovarian reserve drop quite dramatically.

I think I'm being a little unfair . As an IVF specialist , I understand the impact time has on a woman’s fertility, but it’s not something which most women are aware of. After all, there are no symptoms or signs of declining egg quality – and the inexorable ticking of the biological clock is silent.

Most infertile couples prefer doing nothing for many reasons. For one, they lull themselves into a false sense of security . They believe that since fertility is a natural biological process , and that it can take time to have a baby, they just need to be patient for everything to fall into place. This approach is often reinforced by the elders in the family, who often advice patience and a hands-off approach. Also , lots of couples will attribute their infertility to stress, and hope that if they can take time off and go off on a holiday, they’ll be able to have a baby on their own.

Many prefer living in a fool’s paradise. After all, no one wants to face up to the fact that they may have problems conceiving . The fear that they may not be able to make a baby in the bedroom affects their self-esteem , and the first protective response is that of denial .

Many are hopeful that things will sort themselves out. After all, we have all heard stories of uncles and aunts who got pregnant in their bedroom after 10 years of marriage , without doing anything. If it worked for them, maybe it will work for us !

Others adopt “bedroom” techniques and home remedies to try to improve their chances. They change their diet; their sexual position; their sexual frequency; and ask their “super-fertile” friends for tips and advice – many of which are misleading, because they are based on myths and misconceptions. However, when they do try once of these homegrown solutions’ , they need to give it at least 6 months to see if it works or not !

Others have heard so many horror stories about the side effects of IVF treatment, that they refuse to even consider the possibility of medical treatment. Some are scared that IVF treatment is artificial and risky, and that IVF babies are abnormal or defective. This is why they put off going to an infertility specialist . However, this does not mean that they don’t pursue treatment – it’s just that they try alternative options which are more natural and are designed to boost their fertility, such as herbal medicines, ayurveda and acupuncture.

Others go from temple to temple , seeking divine intercession – after all, aren’t babies a gift from God ? He will give us one when the time is right – who are we to challenge his plans for us ?

Many get stuck in wishful thinking , especially when they have irregular cycles. They feel that every month is the month it’s going to work for them – their hopes go up every time they miss their period. They fell – maybe the reason I missed my period was because I did get pregnant and then miscarried, so maybe this month the pregnancy will stick if I rest or change my diet ?

Finally, the major issue is that while infertility is always an important problem , it’s never urgent, so it's always very easy to push it off . Many people plan their life and say - I’ll think about have a baby after I get my promotion / after I have settled down in my new job/ after I can afford it/ after I have bought a new car/ after I have finished my MBA. Unfortunately, you can't always have your cake and eat it too , and you need to make a trade-off . It is perfectly fine to put your job before your baby, provided that this is being is done with realistic expectations . Women need to be aware and well informed about the impact of the passage of time on their fertility. It’s easy to do nothing, but there is a price they pay for this – the opportunity cost, which they forget to factor in, because it is concealed.

Not doing something is also a decision - and sometimes this it's the worst possible decision . It’s the easiest decision to make . It’s much easier to fall back into the passive default mode of we will continue trying in our bedroom, because this is so much easier than the active mode of taking the trouble of going for medical treatment. However, just like actions have consequences, so does inaction.

Others have gone to a doctor for help, but were so put off by the experience, that they refuse to see another doctor. Many patients don’t trust doctors anymore, because they feel they have all become commercial, and just want to make money by ordering expensive tests and doing unnecessary treatments.

Often, infertility becomes the elephant in the room, which progressively becomes a sore issue over which the couple start bickering. The wife wants to go to a doctor, but the husband refuses. He is not willing to spend the money, because he thinks they cannot afford to take such an expensive gamble.

While it’s true that IVF can be expensive, getting an opinion from a good fertility specialist never hurts. You can choose to ignore his advice, but at least you have peace of mind you did explore your options properly. Many couples kick themselves for not doing IVF earlier – but then it’s too late by then.